Provider Demographics
NPI:1720358484
Name:INTERACTIVE MEDICAL SYSTEMS
Entity Type:Organization
Organization Name:INTERACTIVE MEDICAL SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-894-5029
Mailing Address - Street 1:12882 VALLEY VIEW ST
Mailing Address - Street 2:STE 9
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2519
Mailing Address - Country:US
Mailing Address - Phone:714-894-5029
Mailing Address - Fax:310-227-8229
Practice Address - Street 1:10111 S TACOMA WAY
Practice Address - Street 2:STE D-2
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4666
Practice Address - Country:US
Practice Address - Phone:714-894-5029
Practice Address - Fax:310-227-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies